Another Signpost on the Road to the Right

The latest sign of rightward drift in American politics, or at least the Republican Party, came this week when Politico reported that Mitt Romney had asked Michael Leavitt to begin preparing for the transition, in case Romney wins.

Leavitt is a former Republican governor of Utah and former Secretary of Health and Human Services under President George W. Bush. In normal times, those credentials would be more than enough to satisfy most conservatives. But these are not normal times.

You may have read about the conservative backlash to Leavitt already, via my former colleague Jonathan Chait and TPM's Sahil Kapur, among others. If not, though, here's the story:

Leavitt has been an outspoken proponent of creating insurance exchanges: Marketplaces where small businesses could shop for insurance plans. If you follow health policy, then you can guess why conservatives upset: The Affordable Care Act also calls for the creation of exchanges, as part of its scheme to make insurance available to all. Leavitt happens to have a financial stake in the creation of exchanges and he was an advocate for cap-and-trade while serving as administrator of the Environmental Protection Agency, also during the Bush Administration. The combination has drawn the ire of such prominent conservatives and libertarians as Ben Domenech, Philip Klein, and Michael Tanner. The editorial page of the conservative Washington Examiner called Leavitt's place in the Romney heirarchy a "red flag."

But why should exchanges arouse concern from conservatives? The point of creating an exchange is simply to create a buyer's club, so that individuals and small businesses can get the same kinds of group pricing that large businesses get. Utah happens to be one of two states that have functioning exchanges and, as Politico's Jason Millman notes, Leavitt has frequently referred to Utah's exchange as a good model. But it's far more minimalist than the one Romney's law created in Massachusetts or that the Affordable Care Act calls for other states to develop. The Utah exchange doesn't have all the regulations on insurers and it doesn't have the huge subsidies for people and businesses that can't pay for insurance on their own. It doesn't deliver universal coverage or anything close to it. It just lets small businesses pool their resources.

Put it this way: Leavitt's Utah exchange has about the same relationship to the Massachusetts/Obamacare exchanges as a wombat has to human beings. They share some DNA and, if you go far back enough in the evolutionary history, you'll find common ancestry. But they are totally different creatures today.

It's true that Leavitt has not been as openly as hostile to the Affordable Care Act as most conservatives are these days. That may or may not reflect his financial stake in advising states trying to implement it, an issue about which liberals as well as conservatives will undoubtedly be concerned. But, as best as I can tell, conservatives are not reacting simply to Leavitt's possible conflict-of-interest: They're also reacting to his ideological position. And that says as much about those conservatives as it does about Leavitt.

For a long time, the debate between left and right was about how to design the welfare state, not about whether to have one. Conservatives wanted to scale it down and deliver services through the private sector, rather than government, but they accepted the idea that society had some obligation to provide certain services and supports.

The consensus was already eroding by the 1990s, when Newt Gingrich famously called for letting Medicare "wither on the vine." But the consensus still had power as recently as the last decade, when the Bush Administration created Medicare Part D. That program gave seniors prescription drug coverage, as liberals had long advocated, but it offered less generous benefits than liberals wanted and channeled coverage through private insurers rather than government. (It also didn't pay for itself, but that has frustrated liberals as much as, if not more than, it has conservatives.)

It's hard to imagine today's Republicans endorsing anything like Part D. And that's a significant shift. Conservatives never liked left-wing, government-run solutions to problems like unaffordable health care and climate change. These days they don't seem to like right-wing, market solutions, either.

It's an intellectually honest point of view, to which they are certainly entitled. But it does make you wonder. Do they like any solutions at all? Do they even think the problems are worth solving?